The epidemic in Vermont might be caused in part by the incentive big-city drug dealers have to do business in smaller towns. A bag of heroin that would cost $5 in a big city can sell for as much as $30 in Rutland, Vermont, the city's police chief James Baker told Seven Days, an independent newspaper in Vermont. Location is also important. Vermont's proximity to Montreal makes it an attractive stop for drug dealers traveling from Canada.

Barbara Cimaglio, Vermont's deputy commissioner for alcohol and drug abuse programs, told Business Insider in October: "I think Vermont is really in sort of a perfect storm because we're on that highway between Montreal, Boston, New York, and also going to Philadelphia. You have to go through Vermont to get to some of the bigger cities like Boston, so it seems like some people are just trafficking along the way and Vermont is one of the stops."